关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉与前交叉韧带

摘要

目的 评价关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带的临床疗效.方法 14例前、后交叉韧带损伤患者在关节镜下应用异体跟腱同时重建前、后交叉韧带,且后交叉韧带股骨侧应用双束双隧道重建.受伤至手术时间平均19.5 d.术后平均随访34.5个月.采用Lysholm评分和Tegner评分对患膝功能进行评估,通过KT-1000检查膝关节的前后松弛度.术前患者屈膝活动度(123.6±2.5)°,Lysholm评分(52.8±2.2)分,伤前Tegner评分平均为(5.9±0.5)分,术前为(1.2±0.9)分.结果 术后患者屈膝活动度(117.9±2.8)°,与术前比较差异无统计学意义(t=1.54,P=0.14).术后Lachman试验阴性者13例(92.9%),后抽屉试验阴性者12例(85.7%).KT-1000屈膝25°双侧胫骨前后松弛度差值在2 mm以内9例,3～5 mm 4例,6 mm1例.屈膝70°差值2 mm以内10例,3～5 mm 3例,6 mm 1例.Lysholm评分术后提高至(92.9±3.3)分,差异具有统计学意义(t=17.009,P＜0.001).术后Tegner评分终末随访时平均为(5.4±0.8)分.手术前后的差异有统计学意义(F=4.2,P＜0.01).11例恢复到受伤前运动水平(78.6%),另外3例运动水平较受伤前有所降低.结论 关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带,后交叉韧带股骨侧应用双束双隧道重建,更接近后交叉韧带解剖重建,能够恢复膝关节的稳定性,较满意地恢复膝关节功能.%Objectives To introduce the technique of arthroscopic simultaneous reconstruction of posterior cruciate ligament(PCL)using double femoral tunnel,single-bundle transtibial tunnel PCL technique and anterior cruciate ligament(ACL)with achilles allograft,and to evaluate the clinical outcome.Methods Fourteen patients with PCL and ACL injuries after a minimum follow-up 18 months were recieved.Arthroscopically assisted simultaneous ACL/PCL reconstruction with achilles allograft were performed using the single-incision endoscopic ACL technique and the double femoral tunnel,single-bundle transtibial tunnel PCL technique.The Lysholm and Tegner knee score scale were used for functional evaluation.All patients were evaluated with physical examination and KT-1000 arthrometer testing.The mean knee flextion was(123.6±2.5)°preoperatively.The Lysholm score was 52.8±2.2.The Tegner score was 5.9±0.5 before iniury,1.2±0.9 preoperatively.Results The mean time from injury to the reconstructive procedure was 19.5 d.The mean knee fiextion was(117.9±2.8)°postoperatively(t=1.54,P=0.14).As to the Lachman test for 14 patients,the results of 13 patients(92.9%)was negative.As to posterior drawer test,the results of 12 patients(85.7%)was negative.The Lysholm score was 92.9±3.3at final evaluation(t=17.009,P＜0.001).KT-1000 arthrometer testing at 25°knee flexion showed that the side-to-side difference was below 2 mm in 9 cases,3-5 mm in 4 cases,6 mm in 1 case.At 75°knee fexion the difference was below 2 mm in 10 cases,3-5 mm in 3 cases,6 mm in 1 case.The Tegner score was 5.4±0.8 at final evaluation.The difference between the preoperative score and the postoperative was statistically significant(F=4.2,P＜0.01).Conclnsions Combined ACL and PCL injuries can be Successfully treated with arthroscopic simultaneous reconstruction of PCL using double femoral tunnel technique and ACL with achilles allograft.The double femoral tunnel technique more closely approximates the anatomic insertion the native PCL.Most patients recover a functionally stable knee.